Antidepressants

Prof. Philip Cowen Professor of Psychopharmacology Department of Psychiatry University of Oxford, UK This presentation summarizes recent findings on the role of inflammation in depression. A study suggests patients with elevated levels of inflammatory markers (C-reactive protein) have a differential response to a specific antidepressant. The efficacy of celecoxib and infliximab in treatment-resistant depression is…

Author: Flavio Guzman, MD Mirtazapine (Remeron) is a noradrenergic and specific serotonergic antidepressant (NaSSA), it doesn’t have effects as monoamine reuptake inhibitor. A significant feature is its effect as histamine 1 antagonist. This antihistamine effect is linked to sedation and weight gain. Mirtazapine is commonly used in the elderly population. In this group of patients…

Author: Flavio Guzman, MD Besides being a SERT inhibitor, fluvoxamine is an agonist at sigma 1 receptors. The drug is approved in the US for the treatment of OCD but not depression. This is interesting as this is a widely used antidepressant in other countries. Fluvoxamine has the potential for drug-drug interactions through inhibition of…

Author: Flavio Guzman, MD Sertraline is a moderate inhibitor of CYP2D6. In terms of drug-drug interactions this is not as significant as with fluoxetine or paroxetine. It has a similar side effects profile to other SSRIs. The dosage range goes from 50 to 200 mg/day. Pharmacology and MOA Sertraline is an inhibitor of the…

Author: Flavio Guzman, MD Discontinuation symptoms can occur with all antidepressant classes, and you will see many articles referring to SSRI discontinuation syndrome. The reason is that SSRIs are by far the most commonly prescribed antidepressant class. This syndrome consists of usually mild and reversible symptoms that can be grouped into six categories. As a…

Author: Flavio Guzman, MD Fluoxetine has activating properties that make it a good option for patients with retarded depression or atypical depression. However, we should avoid activation in patients with insomnia and agitation. There is something that makes fluoxetine unique: its long half-life, we will discuss the advantages and disadvantages of this in clinical practice.…

In this episode we interview Dr. Derek Tracy on the use of bupropion for depression. Dr. Tracy is a Consultant Psychiatrist and the Associate Clinical Director for Crisis, Inpatient, and Rehabilitation services at Oxleas NHS Foundation Trust, London. He is a BRC research fellow and the neuromodulation lead at the Institute of Psychiatry, Psychology, and Neuroscience, King’s…

Author: Flavio Guzman, MD Paroxetine (Paxil, Seroxat, Aropax) is an SSRI approved for major depressive disorder and most anxiety disorders. In clinical practice, many clinicians use it for patients with anxious depression. However, this observation hasn’t been specifically studied in randomized controlled trials. Regarding its side effects profile, important features include higher risk for sexual…

Treatment of obsessive compulsive disorder is often challenging. Treatment resistance is quite common, between 40 to 60% of patients do not show and adequate response to first-line treatments. We invited Dr. David Veale to comment on his meta-analysis published in BMC Psychiatry : “Atypical antipsychotic augmentation in SSRI treatment refractory obsessive-compulsive disorder: a systematic review…

In this expert interview we discuss side effects of antidepressants. Our guest today is Dr. Rajnish Mago. Dr. Mago currently serves as Director of the Mood Disorders Program at the Thomas Jefferson University Hospital in Philadelphia, Pennsylvania. He is Associate Professor of Psychiatry at the Jefferson Medical College. He recently published the high-yield book “Side…